A multistate outbreak of gastrointestinal illness caused by enterotoxigenic Escherichia coli in imported semisoft cheese

J Infect Dis. 1985 Apr;151(4):716-20. doi: 10.1093/infdis/151.4.716.


In September 1983, three clusters of gastrointestinal illness with similar symptoms affected 45 persons in Washington, D.C., after office parties. The illness lasted a mean of 4.4 days and was characterized by watery diarrhea (91%), abdominal cramps (80%), headache (38%), nausea (38%), and subjective fever (20%). Illness was strongly associated with having eaten imported French Brie cheese one to six days before onset of illness (P less than .0001 by Fisher's two-tailed exact test). After publicity about these outbreaks, additional cheese-associated cases were identified over an eight-week period in Illinois, Wisconsin, Georgia, and Colorado. Stool specimens from ill persons in four states yielded Escherichia coli serotype O27:H20. These organisms produced heat-stable enterotoxin and had similar plasmid profiles. When commercially distributed foods are contaminated, enterotoxigenic E. coli can cause widespread disease even in a developed country, and the disease can easily escape correct diagnosis.

MeSH terms

  • Adolescent
  • Adult
  • Bacterial Toxins*
  • Cheese / poisoning*
  • Colorado
  • Disease Outbreaks*
  • District of Columbia
  • Enterotoxins / biosynthesis
  • Escherichia coli / classification
  • Escherichia coli / genetics
  • Escherichia coli / isolation & purification
  • Escherichia coli / metabolism
  • Escherichia coli Infections / epidemiology*
  • Escherichia coli Infections / microbiology
  • Escherichia coli Infections / transmission
  • Escherichia coli Proteins
  • Feces / microbiology
  • Female
  • Food Microbiology*
  • Gastrointestinal Diseases / epidemiology
  • Gastrointestinal Diseases / etiology*
  • Georgia
  • Humans
  • Illinois
  • Male
  • Middle Aged
  • Plasmids
  • Wisconsin


  • Bacterial Toxins
  • Enterotoxins
  • Escherichia coli Proteins
  • heat stable toxin (E coli)